All politics is local …and global

The victory of the Republican candidate Scott Brown in the
Massachusetts senatorial race has been greeted by many as an important
indicator of the future direction of American politics and as very bad
news for President Obama.

The symbolism for the Obama administration is indeed ominous: on the
one-year anniversary of Obama’s inauguration the voters of
Massachusetts, called by many the most Democratic state in the Union,
voted in a Republican to fill the Senate seat vacant since the death of
Ted Kennedy in August of last year. Kennedy was a stalwart of the
Democratic Party, having served in the Senate for the best part of half
a century.

It would seem at first glance that if the citizens of ‘Democratic
Massachusetts’ are ready to vote in a Republican who campaigned
centrally against the Obama
healthcare reform (also Kennedy had for decades been championing the
reform of the US healthcare system) it marks the end for the
President’s keynote domestic policy objective for his first year in
office - healthcare reform. The logic runs that if even ‘true blue’
Massachusetts has voted red now, the Democrats are in for a kicking in
the mid-term elections later this year.

But there is a local context to this that should not be missed.
Brown’s opponent, Democrat Martha Coakley, is reckoned to have run a
terrible campaign. Yet more interestingly, the reason why Brown made
political headway with the “we don’t want to pay for healthcare reform”
line is that Massachusetts has previously taken huge strides in
reforming its own state-wide healthcare system. Although a number of
healthcare economists are now openly questioning the success of the
Massachusetts reforms, the state has gone as far as any in attempting
to deal with the structural problems that face the hybrid US healthcare
system.

In the Massachusetts system everyone is obliged to have health
insurance, but the poorest get it for free and subsidised care is
available for other low and lower income groups. Cheaper insurance is
available in part because the number of insured people increased to
include the fit and young, and in part through state subsidy, which
became affordable as the expenses to the state caused by the uninsured
going to hospital emergency rooms also fell.

Many of the ideas in the Massachusetts plan were incorporated into
the various plans that have been discussed nationally in the last year.
It should also be noted that the healthcare reform was passed by a
centrist Republican governor of the state, Mitt Romney, who would
subsequently become much better known as one of the most serious
contenders for the Republican nomination for the 2008 presidential
election. When Romney ran his national campaign he moved significantly
to the right of his record in Massachusetts.

Brown’s “no new taxes to fund the healthcare of others” calls would
have resonated in a state that had already fought the battle to provide
something approaching universal healthcare and that is now also paying
the costs that stem from that decision. It will be ironic if
Massachusetts, already having virtually universal care, becomes the
state that blocks healthcare reform for the rest of the country by
sending a 41st Republican to the Senate and giving the GOP a
blocking minority. The vote will ripple outwardsglobally as well; an
Obama administration battling domestically will have less energy for
its foreign policy efforts. Another failure to reform the US healthcare
system will also have important ramifications for the long term
strength of the American economy and hence the country’s place in the
world.